Add or Edit Basic Payer Information

Launching Payer Settings in Billing

From the Edit menu, select Payers, press F11, or click to access basic payer information.

Payer Demographics Tab

Payer address and contact information is entered here as illustrated. Unfortunately, there is not a standard naming convention for insurance plans. The name may include a numeric descriptor to distinguish it from other plans from the same company. If the insurance plan address includes a PO Box, we suggest appending the PO Box Number to the plan name. For example, there may be several AARP plans, such as AARP Health Care Options (13999), AARP Health Care Options (740819), and so on.

Browse Payers or Credentials

To browse payers or credentialed staff for a given payer, you can click Browse Payers or Browse Credentials. In both cases, you do not need to select a payer from the Payer list in order to display a list of all payers.

Click Browse Payers to display the Browse Payers dialog. You can use this dialog to review payer information for all payers in your system.

Click Browse Credentials to display the Browse Credentials dialog. You can use this dialog to review a list of all payers in your system and identify which payers require credentialing and which of your staff members are credentialed for a given payer.

Adding or Editing Payers

To add a new payer, click the New Payer button and complete the fields on this tab as well as the other tabs on the Edit Payer dialog box. To edit an existing payer, select a name from the Payer drop-down list.

  1. Enter the name of the insurance company or plan in the Name text box. The name may include a numeric descriptor to distinguish it from other plans from the same company. For example, there may be several AARP plans, such as AARP Health Care Options (13999), AARP Health Care Options (740819), and so on. Enter the payer's contact information in the Attn and Contact text boxes.
  2. Note: Payer names must be less than 60 characters, including spaces. If the payer name is too long, claims may be rejected by your clearinghouse.

  3. Select the correct Payer Category from the drop-down list. You can select Commercial Insurance, Facility, Litigation, Managed Care, Medicaid, Medicare, or Workers Comp. Once you select one of these categories, a two-character abbreviation displays next to the Category. These categories play a crucial role in reporting and analysis.
  4. Check the Active check box if the payer is active. Active payers will be available in the payer drop down menu in the Payer Information section of the Client Editor.
  5. Address Info (Address Lines 1 and 2, Zip, City, and State): Enter the payer's address in the fields in the Address area. If you enter a valid Zip code, the City and State are automatically filled in.
  6. Phone (Telephone, Extension, and Fax): Enter contact information for the staff member in the Phone area. You do not need to enter punctuation to separate area codes and phone number prefixes. They are automatically provided.
  7. Enter any additional information you would like to record about the payer. Clinicient recommends including the payer's timely filing period policy, whether or not your clinic is in network or out of network with the payer, and if the payer does not accept electronic claims, whether or not chart notes are required.

Note: When Total INSIGHT clients enter a new payer, a system-generated task is automatically assigned to Clinicient's Payer Intelligence team, alerting them to review payer set up.

Proceed to General Billing Data Tab to continue payer setup.

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